Health Care Lessons From Israel

In the debate over health care reform, what can the United States learn from Israel? Dr. Dani Filc, author of "Circles of Exclusion: The Politics of Health Care in Israel," has some ideas. Filc is a senior lecturer in the Department of Politics and Government at Ben Gurion University and chairman of Physicians for Human Rights - Israel. "Circles of Exclusion" was published in June by Cornell University Press.

GUEST BLOGGER: Dani Filc

The current discussion about health care reform in the United States sounds strange for anyone living in a country with a public, universal, health care service. Indeed, it is difficult to consider a country that does not guarantee its citizens universal access to health care as a true democracy.

For those who have no access to health care, basic principles like equality of opportunity are empty slogans. You cannot be an active member of the political community if you are not healthy enough, and although access to health care services is not the main contributor to health, still its importance is undeniable.

(John Moore/Getty Images)

Thus, health care cannot be considered as any other commodity, to be bought and sold in the free market. Rather, access to health care must be universal and guaranteed by the state.

This is the reason, as President Obama claimed, most democratic societies guarantee the right to health care services. This is why for me the public option is actually a no brainer. Without it, one of the most basic human rights, as recognized by the Universal Declaration of Human Rights, is denied.

This is not to say that once a public option is adopted, other problems do not emerge. In Israel, unfortunately, a gap exists between the theoretical commitment to universal health care services and its implementation. Theoretically, Israel guarantees access to health care to every inhabitant.

The National Health Insurance law of 1994 declares that equal access to health care is a right. The law guarantees every Israeli a relatively broad health care basket of services. The Israeli system combines the advantages of single payer systems, with choice between different providers. In order to cover health expenditure, every citizen pays some 5 percent of his or her income as an ear-marked health-tax and the state adds monies from the general budget. Services are provided by four public, non-profit, health management organizations, with the state remaining responsible as a last resort.

Unfortunately, in practice there are several obstacles for the real enjoyment of the right of access to health care services. First, the Palestinians in the Occupied Territories do not enjoy access to health care services since they are not covered by the National Health Insurance law. Moreover, Israel did not allow for the development of good quality services in the Occupied Territories and has dramatically restricted the freedom of movement which severely limits access to health care.

Second, the Israeli structure of citizenship excludes migrant workers from access to the public health care system. Documented migrant workers are insured with private insurers that provide much more limited coverage than the public system. Undocumented migrants lack regular access to health care and have access only to very limited services: life saving emergency medicine, pregnancy and well-baby follow up, and treatment for specific diseases such as tuberculosis and sexually transmitted diseases.

Third, while the Israeli Arab minority is covered by the National Health Insurance system, its health indicators are worse than those of the Jewish population. This stems from differences in the social determinants of health such as poverty or geographical segregation and other inequalities caused by segregation and lack of development of culture-sensitive health care services.

Finally, the neo-liberalization of Israeli society has eroded the Israeli health care system. During the last decade there is a tendency to shift costs from the state to the individual citizen in the form of increasing copayments, and restrictions on the development of the public sector are driving those who are able to pay to buy complementary private insurance.

As a result, inequalities in access to health care services have increased, and in the past decade about forty percent of Israel's poorest population claimed that they have refrained from buying prescription drugs or visiting a physician because of high copayments.

What can the Israeli case teach Americans during a period of heated debate over health care reform?

While the prolonged occupation, the discrimination and segregation of migrant workers and discriminatory treatment of the Israeli Arab minority have built circles of exclusion from access to health care, all those who are included within the public insurance system enjoy an efficient, broad and still relatively generous health care system. Indeed, the overall health indicators in Israel are better than those of the United States.

The combination of a single-payer system with the possibility to choose between four public providers makes the system relatively equal, efficient and broad. Eighty percent of Israeli citizens are satisfied with their provider and Israel's national health expenditure is slightly lower than 9 percent of GDP, which is slightly more than half the American national expenditure on health.

Even though physicians earn considerably less in Israel than in the United States, as a practicing physician I can say than we enjoy more clinical freedom and significantly less paperwork than American physicians dealing with for-profit HMO's and insurance companies. Moreover, when thinking about health policy we need to think much more about the benefit of patients and not of physicians.

Americans, in sum, can learn a great deal from Israel. The advantages of a public single payer health care system which leaves room for individual choice is something that they should adopt without hesitation.

Comments

If you would like to help pressure Congress to pass single payer health care reform (medicare for all) please join our voting bloc at:
www.votingbloc.org

Posted by: letsgobuffalo | September 24, 2009 6:38 AM

Fascinating.

Is this blog still about books - or is it a second Outlook section?

Posted by: 217RMD | September 24, 2009 9:50 AM

From Steven Levingston, nonfiction editor of Book World.
Thanks for your question, 217RMD.
The blog is about the significant and newsworthy ideas that new books contain, with contributions from people who have spent years, sometimes a lifetime, studying those ideas, AND the blog still is -- and always will be -- about fiction, the publishing industry, e-books and other matters of importance to the literate.

Posted by: levingstons | September 24, 2009 10:19 AM

I wonder how much greater clinical freedom corresponds to the medical malpractice litigation climate (or lack thereof) in Israel.

U.S. healthcare reform should first look to stem the tide of massive malpractice lawsuits in our courts. It won't happen though because the trial lawyers have a powerful lobby and deep pockets.

I disagree that having your healthcare paid for by others is a universal human right. Freedom from such intrusion should be a right.

Posted by: stuart806 | September 24, 2009 2:27 PM

Great post! These differences become really relevant in a crisis situation as well, like the H1N1 pandemic may precipitate. More on this here:

When I read equality, I begin to wonder whre the heatlh care is for the Palestanians in Gaza and Israel?

Israel is not equal, as Muslims are not equal to Jews In Israel, as can be seen by two separate systems, one for Jews and a different one for Muslims.

Patrick

Posted by: patmatthews | September 24, 2009 2:40 PM

For those of you who do not really grasp how things are here in Israel, even with the information in the article, there are 1.6 million Israeli arabs and non-Jews who are citizens of Israel and have the same health care benefits that all Israeli Jews receive. We also treat illegal immigrants many of whom arrive ill and in need of medical treatment for free. When the author claims people do not seek out medical care because of high co-payments. that is somewhat misleading. Co-payments that I pay to see my specialist once a year is 19 shekelim or approximately $4. One prescription drug which I take daily cost me 19 shekelim a month. After open heart surgery three years ago, I never saw a bill from the treating cardiac specialist, hospital or anyone else for that matter.

Posted by: rlgrennie1 | September 24, 2009 3:51 PM

Mr. Levingston,

Your response to 217RMD is a self-serving lie and you know it. Yes, the guest bloggers you publish on this site do have books in print but the views of the writers you publish are always liberal. In reality, you pick and choose the writers you invite on here based on whether their books support your liberal point of view.

However, if you are really are interested in spreading "significant and newsworthy ideas that new books contain", then surely you can identify the last three conservative authors you have sought to guest post on Short Stack? Or is it just coincidence (and not your inherent bias) that all of the newsworthy and significant ideas worth addressing here are liberal by nature?

Posted by: alvint | September 24, 2009 4:06 PM

Oh no! Not another successful example of an evil socialist/communist medical system for all that's effective and treats people as valuable! Could it be that this model actually works and the insurance industry and GOP are wrong?

Posted by: gce1356 | September 24, 2009 4:20 PM

The blogger is taking this opportunity to bash Israel. The bulk of the comments (4 paragraphs) list reasons to resent Israel. However, all the reasons listed just confirm that the National Health is limited to citizens. Even Arab citizens. That's all. But the blogger finishes with a couple of short paragraghs that actually list the advantages to the Israeli system. And that is exactly what the topic should be. No health care system is perfect. But I was very satisfied with Israeli health care. It is modern, available and eliminates many of the problems of the US system. Hey, how about comparing the Israeli system to the US "commercial, receive care if you can afford it" system? Just try being a Mexican migrant worker in the US. How about the minimum wage McJob worker? What kind of health care do his children receive? Nothing, I see. That's the differnce between the systems. Sure, as the blogger mentions, sometimes low-income Israelis will forgo some medication if the co-pays are too high or the prescription is just not really needed...wouldn't anyone? In sum, the blogger takes a swipe at a superior medical system, and can not really justify the criticism.